Resource Allocation and Obstetrician Practice—an idea of obstetricalquality index

Presenters: Chin-Hung Lin, Department of Obstetrics and Gynecology, Buddhist Tzu Chi General Hospital and Yi-Chen Hong ,Chinese Culture University

Abstract

Rationale
When obstetricians perform either a cesarean section (CS) or vaginal delivery (VD),they need support from the staff and facilities of their hospitals. These hospital resources are usually plentiful on weekdays but limited on the weekend. Therefore, obstetricians could not have the convenience to offer services as they or their patients wish. The constraint on the scheduling of a CS might be even stronger than that of a VD because a CS event needs more resources supported from a hospital. Some types of CS, such as previous CS, breech presentation, and some instances of medical disease, are flexible in timing, but some urgent CS’s for fetal distress and pelvic dystocia occurring during labor cannot be scheduled. Naturally, obstetricians schedule non-urgent CS’s on weekdays to avoid working with limited resources. Then the number of non-urgent CS would follow a regular wave pattern like the availability of hospital support. However, the numbers of VD and urgent CS’s are supposed to have no regular pattern if obstetricians have sufficient hospital support to face the risk of unexpected deliveries.

Objectives
This paper is to analyze whether the numbers of VD, urgent and non-urgent CS’s follow a regular wave pattern like the availability of hospital resources.

Methodology
Data analyzed in this study, including CS's and VD, were extracted from 2003 to 2005 in patient claim databases of the NHI in Taiwan. These CS indicators had been divided into two categories. One is urgent, including dystocia, fetal distress and cord prolapse. The other is non-urgent, including previous CS, breech presentation and medical diseases indicators. Non-urgent CS's could be scheduled on weekdays, but VD and urgent CS could not. Then, the chi-square goodness-of-fit test is applied to test if the weekly distributions of VD, urgent non-urgent CS follow a specific uniform distribution.

Results
For private and public hospitals, the significance of the chi-square test statistics shows that the weekly distributions of VD are similar to a uniform distribution. The weekly distributions of non-urgent CS deviate from the uniform distribution. However, the chi-square statistics of urgent CS’s are also significant like non-urgent CS’s. And, the statistics for public hospitals exceed those for private hospitals. These results show that urgent CS’s have the similar distribution with non-urgent CS’s.

Conclusions
Since non-urgent CS’s could be scheduled, obstetricians tend to arrange these services on working days to avoid risk. In this study, not only the number of non-urgent CS but also that of urgent CS have the regular wave pattern which is correlated with the staff and facilities available in hospitals. The poor resources have impacted the obstetricians' behavior, such that the timing of an urgent-CS might be decided by non-medical reasons. The results imply that the distribution or wave pattern of urgent CS could reflect whether obstetricians have sufficient resource support and might be translated into a quality index for obstetrics departments.